CN102065775A - Ultrasound guided systems and methods - Google Patents
Ultrasound guided systems and methods Download PDFInfo
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- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
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Abstract
Coblation probes, systems and methods are described herein, along with tissue dilation apparatus, and kits including both. The articles may be ultrasonically echogenic to assist with guidance.
Description
Related application
According to united states patent law the 119th (e) bar, the application requires following U.S. Provisional Application No.: the denomination of invention of submitting on February 20th, 2008 is the serial number 61/030 of " ultrasonic cryogenic ablation pseudomorphism mitigation system and method " (ULTRASOUND COBLATION ARTIFACT REDUCTION SYSTEMS AND METHODS), 076, and the denomination of invention of submitting on February 20th, 2008 is the serial number 61/030,085 of " ultrasonic guidance tissue expander equipment " (ULTRASOUND GUIDED TISSUE DILATION APPARATUS).These two provisional application are all included this paper by reference in full in.
This paper has described the tissue low-temperature that can be used in the ultrasonic guidance operation and has melted (coblation) equipment and/or tissue expander equipment.
The cryogenic ablation device is with the tissue that removes a plurality of positions in the body, as what discussed among for example U.S. Patent number 6,296,638 (Davison etc.), 5,697,281 (Eggers etc.) and 5,683,366 (Eggers etc.).In some cases, these devices can be used to remove tendon and other soft tissue (using for example miniature cleanser of TOPAZ (the TOPAZ MicroDebrider of ArthroCare Sportsmedicine) of joint treatment sports medical science company) of pathological changes by open operation and arthroscope operation.
Though the cryogenic ablation device can be used for removing tissue, be to use the debridement of radio frequency (RF) energy generally can produce the gas that forms bubble.In some cases, the formation of bubble is favourable.Yet for ultrasonic energy, these bubbles have very high intensity reflection coefficient (IRC).So the cryogenic ablation device also is not used in the ultrasonic guidance operation, because the pseudomorphism that bubble causes can hinder accurate visual observations ablation site.
Except the problem that cryogenic ablation causes, also have soft tissue (for example, nerve, blood vessel, tendon etc.) various clinical settings such as contraction in vivo.These contractions can cause stimulation, inflammation and pain.
These situations are often treated (for example, anti-inflammation drugs therapy, steroid injection etc.) by rest and antiinflammatory measure.
In the situation that these are failed to respond to any medical treatment, may need surgical operation to loosen and/or remove shrinkage tissue.Yet surgical operation is loosened and/or removed shrinkage tissue generally need be with the open surgery of certain expense and sickness rate.
General introduction
Cryogenic ablation system and method described herein provides the fluid stream that flows to ablation site, makes the bubble that forms in the ablation operation be removed with given pace, thereby can carry out the ultrasonic guidance operation.In described system and method,, remove fluid by one or more suction channels simultaneously by one or more passage delivery of fluids of sending.So described fluid preferably moves into and shift out ablation site, remove and come along with the fluid that enters one or more suction channels as the bubble that an ablation procedure part forms.The fluid that uses can comprise for example Lactated Ringer'S Solution, and other is applicable to the solution of cryogenic ablation operation.
The fluid stream of ablation site can advantageously limit a part of as ablation procedure and side tissue injury that heat energy that produce causes.In some embodiments, be delivered to the fluid of ablation site can cool to room temperature following (for example, being cooled to be lower than 20 ℃).Cooling fluid can strengthen the thermal control of ablation site, because compare with the warmer fluid that is delivered to same position, described fluid can absorb more frequent fever energy.
The fluid stream of control inflow and outflow ablation site helps to limit the contingent ablation site of conventional fluid delivery system surrounding soft tissue and excessively soaks into.This control can comprise by this system more accurate and control in phase that fluid is sent, fluid removes and the RF energy.
In addition, remove fluid from ablation site and also removed tissue and/or other waste product.
In some embodiments, described system can comprise controller, and this controller starts fluid flow and removes fluid in the seclected time before sending the RF energy, stops back fluid flow and fluid and removes and continue the selected time and send at the RF energy.For example, embodiment can be sent preceding 0.5 second or start fluid in shorter seclected time and be sent/removes at the RF energy, stopped the back fluid and transported/remove lasting 1 second or longer time and send at the RF energy.For system and method for the present invention, also can use other selected time.
Except the cryogenic ablation system and method, the present invention also comprise can with cryogenic ablation system coupling or can be not and the tissue expander equipment and the method for cryogenic ablation system coupling.In some embodiments, can utilize tissue expander equipment described herein and method, thereby adopt the dermal delivery tissue distention device of ultrasonic guidance path to be provided and/or to alleviate non-cardiostenosis for non-cardiostenosis.In use, this tissue expander equipment can be delivered to the zone (for example due to scar tissue, the adhesion etc.) of tissue contracts.Described tissue expander equipment preferably includes the ultrasonic echo generating material, thereby can determine the position of the expansion of this equipment with ultrasonic guidance at least.When being positioned at a selected position, the expandable part of tissue expander equipment is inflatable, thus for example destroy scar tissue, discharge adhesion or relief of symptoms narrow.Described tissue expander equipment can also comprise an inner chamber, and the cryogenic ablation system can arrive the target body tissue through this inner chamber.
May utilize some more common clinical settings of tissue expander equipment treatment described herein to comprise, for example de Quervain's disease (for example " the plate machine refers to ") and entrapment neuropathy (for example, carpal tunnel syndrome, oar pipe syndrome etc.).Except being used for direct treatment, tissue expander equipment described herein also can be used to produce the working area into other ultrasonic guidance operation described herein.For example, described device can be used for producing " working area " into other percutaneous operation.Possible clinical practice can include, but are not limited to: carpal tunnel release, plate machine refer to loosen, the sending etc. of ultrasonic guidance injection or suction, therapeutic agent.
In some cases, can pass through, for example therapeutic ultrasound energy (thereby for example heat tissue is so that its expansion), RF energy, cryogenic ablation, laser energy and/or contraction is loosened together and strengthen the treatment that tissue expander equipment described herein provides with for example cutting tip (cutting blade) etc.
The cryogenic ablation system that one side provides ultrasonic artifacts to alleviate, this system comprises the bar with near-end and far-end; One or more through this bar from the send inner chamber of near-end to remote extension; One or more through this bar from the aspiration lumen of near-end to remote extension; With described one or more inner chamber and coupled fluid control appliances of one or more aspiration lumen fluid sent; Through the cryogenic ablation probe that this bar extends, wherein said cryogenic ablation probe comprises the cryogenic ablation tip near this bar far-end; With the coupled cryogenic ablation energy of this cryogenic ablation probe operation so that the cryogenic ablation energy is delivered to the cryogenic ablation tip; And the system controller that is connected with cryogenic ablation energy operability with the fluid control appliance, wherein this system controller also: the running of control fluid control appliance, thereby fluid is sent the far-end that inner chamber is delivered to this bar through one or more, and at least a portion fluid is removed from the far-end of this bar through one or more aspiration lumen; The running of the control cryogenic ablation energy is delivered to the cryogenic ablation tip so that have with the cryogenic ablation energy selectivity; The operating fluid control appliance, thus in the seclected time when the cryogenic ablation energy is delivered to the cryogenic ablation tip or before it fluid is delivered to the far-end of this bar; With the operating fluid control appliance, thereby in the seclected time after the cryogenic ablation energy is delivered to that cryogenic ablation is most advanced and sophisticated and stops fluid is delivered to the far-end of this bar.
In a plurality of embodiments, described cryogenic ablation system can comprise one or more following features: the fluid control appliance can comprise temperature control device; Described cryogenic ablation probe can maintain the fixed position with respect to described bar; Described cryogenic ablation probe can move in described bar, thereby described cryogenic ablation probe has retracted position, and the tip of wherein said cryogenic ablation probe also has extended position near the far-end of described bar, the tip of wherein said cryogenic ablation probe and the far-end of described bar separate, or the like.
The cryogenic ablation device is provided on the other hand, and it comprises the bar with near-end and far-end; One or more through this bar from the send inner chamber of near-end to remote extension; One or more through this bar from the aspiration lumen of near-end to remote extension; Through the cryogenic ablation probe that this bar extends, wherein this cryogenic ablation probe comprises the cryogenic ablation tip near this bar far-end; Wherein this cryogenic ablation probe is removable in this bar, thereby this cryogenic ablation probe has retracted position, wherein the tip of this cryogenic ablation probe also has extended position near the far-end of this bar, and wherein the far-end of the tip of this cryogenic ablation probe and this bar separates.
The method of removing tissue is provided on the other hand, and the cryogenic ablation system that provides is provided this method, and this system comprises the bar with near-end and far-end; One or more through this bar from the send inner chamber of near-end to remote extension; One or more through this bar from the aspiration lumen of near-end to remote extension; With described one or more inner chamber and coupled fluid control appliances of one or more aspiration lumen fluid sent; Through the cryogenic ablation probe that this bar extends, wherein said cryogenic ablation probe has the cryogenic ablation tip near this bar far-end; And with the coupled cryogenic ablation energy of described cryogenic ablation probe operation so that the cryogenic ablation energy is delivered to the cryogenic ablation tip.Described method also comprises the far-end of this bar that adopts the close ablation site in ultra sonic imaging location; Through one or more inner chambers of sending fluid is delivered to ablation site; Remove fluidic at least a portion of ablation site through described one or more aspiration lumen; With the cryogenic ablation energy selectivity is delivered to the cryogenic ablation tip so that remove the tissue of ablation site; Wherein fluid is delivered to ablation site in the seclected time when the cryogenic ablation energy is delivered to the cryogenic ablation tip or before it; And in the seclected time after the cryogenic ablation energy is delivered to that cryogenic ablation is most advanced and sophisticated and stops fluid is delivered to and melts the site.
In a plurality of embodiments, described method can comprise one or more following features: fluid is delivered to ablation site being lower than under 20 ℃ the temperature; Described cryogenic ablation probe can move in described bar, thereby described cryogenic ablation probe has retracted position, the tip of wherein said cryogenic ablation probe is near the far-end of described bar, also has extended position, the tip of wherein said cryogenic ablation probe and the far-end of described bar separate, described method can be included in and move described cryogenic ablation probe between retracted position and the extended position, wherein can carry out when fluid is delivered to ablation site at mobile described cryogenic ablation probe between retracted position and the extended position; Or the like.
Another provides tissue expander equipment, and this equipment comprises the ultrasonic echo generation bar with near-end and far-end, and wherein the longitudinal axis extends between near-end and far-end, and wherein said bar comprises pipe, and the pole length of wherein said bar along the longitudinal axis from near-end to remote extension; The expansion gear of the far-end of close described bar, wherein said expansion gear has the configuration of subsiding and expanded configuration, wherein said expansion gear has the radial dimension with respect to the longitudinal axis in respectively subside configuration and expanded configuration, and the radial dimension of expansion gear of wherein taking expanded configuration is greater than the radial dimension of the expansion gear of the configuration of taking to subside; With along described bar from near-end to the inflation lumen of remote extension, wherein said inflation lumen and described expansion gear internal fluid communication.
In a plurality of embodiments, described tissue expander equipment can comprise one or more following features: the main channel can be extended between proximal openings and distal openings through described bar; Described bar can be a rigid rod; Described bar can be the rigid metal bar; The radial dimension of taking the expansion gear of expanded configuration can be to take to subside at least 1.5 times of radial dimension of expansion gear of configuration; Described expansion gear can be an inflatable bladders; Described expansion gear can be along at least 25% of described bar extension rod length; Described inflation lumen can be through one or more hole and described expansion gear internal fluid communication of opening to described expansion gear inside, and wherein said inflation lumen is extended through the inside of described bar.
The cryogenic ablation and the tissue expander tool set that comprise cryogenic ablation device and tissue expander equipment are provided on the other hand.Described cryogenic ablation device comprises the cryogenic ablation bar with near-end and far-end; One or more through this cryogenic ablation bar from the send inner chamber of near-end to remote extension; One or more through this cryogenic ablation bar from the aspiration lumen of near-end to remote extension; With the cryogenic ablation probe that extends through this cryogenic ablation bar, wherein said cryogenic ablation probe comprises the cryogenic ablation tip near this cryogenic ablation bar far-end.Described tissue expander equipment comprises the ultrasonic echo generation expanding bar with near-end and far-end, wherein the longitudinal axis extends between near-end and far-end, and wherein extend through this expanding bar the main channel, the cryogenic ablation bar that the size of described main channel should allow the cryogenic ablation device from this expanding bar near-end to distal advancement; Expansion gear near this expanding bar far-end, wherein this expansion gear has the configuration of subsiding and expanded configuration, wherein said expansion gear has the radial dimension with respect to the longitudinal axis in respectively subside configuration and expanded configuration, and the radial dimension of expansion gear of wherein taking expanded configuration is greater than the radial dimension of the expansion gear of the configuration of taking to subside; With along this expanding bar from near-end to the inflation lumen of remote extension, wherein said inflation lumen and expansion gear internal fluid communication.
In a plurality of embodiments, described tool set can comprise one or more following features: cryogenic ablation probe movably in described cryogenic ablation bar, thereby this cryogenic ablation probe has retracted position, wherein the tip of this cryogenic ablation probe is near the far-end of described bar, also have extended position, wherein the far-end of the tip of this cryogenic ablation probe and described bar separates; With described one or more inner chamber and coupled fluid control devices of one or more aspiration lumen fluids sent; With the coupled cryogenic ablation energy of this cryogenic ablation probe operation, so that the cryogenic ablation energy is delivered to the cryogenic ablation tip; The system controller that is connected with cryogenic ablation energy operability with this fluid control device, wherein said system controller is also controlled the running of fluid control appliance, thereby fluid is sent the far-end that inner chamber is delivered to this bar through one or more, and have at least a part of fluid to remove from the far-end of this bar through one or more aspiration lumen; Control this cryogenic ablation energy running in case with the cryogenic ablation energy selectivity be delivered to the cryogenic ablation tip; The operating fluid control appliance, thus in the seclected time when the cryogenic ablation energy is delivered to the cryogenic ablation tip or before it fluid is delivered to the far-end of bar; With the operating fluid control device, thereby in the seclected time after the cryogenic ablation energy is delivered to that cryogenic ablation is most advanced and sophisticated and stops fluid is delivered to the far-end of bar; Or the like.
The cryogenic ablation system that can provide ultrasonic artifacts to alleviate on the other hand.Described system can comprise the bar with near-end and far-end; One or more through described bar from the send inner chamber of near-end to remote extension; One or more through described bar from the aspiration lumen of near-end to remote extension; With described one or more inner chamber and coupled fluid control devices of one or more aspiration lumen fluids sent; Through the cryogenic ablation probe that described bar extends, wherein said cryogenic ablation probe comprises the cryogenic ablation tip near the far-end of described bar; With the coupled cryogenic ablation energy of described cryogenic ablation probe operation, so that the cryogenic ablation energy is delivered to the cryogenic ablation tip; The system controller that is connected with cryogenic ablation energy operability with the fluid control appliance.The running of described system controller control fluid control appliance, thus fluid is sent the far-end that inner chamber is delivered to bar through one or more, and have at least a part of fluid to remove from the far-end of bar through one or more aspiration lumen; Described system controller is also controlled the running of the cryogenic ablation energy, so as with the cryogenic ablation energy selectivity be delivered to the cryogenic ablation tip; Wherein said system controller operating fluid control appliance, thus in the seclected time when the cryogenic ablation energy is delivered to the cryogenic ablation tip or before it fluid is delivered to the far-end of bar; Wherein said system controller operating fluid control appliance, thus in the seclected time after the cryogenic ablation energy is delivered to that cryogenic ablation is most advanced and sophisticated and stops fluid is delivered to the far-end of bar.Described fluid control appliance also can comprise can choose the temperature control device that is connected and is subjected to its control with the system controller operability wantonly.
The method of utilizing cryogenic ablation to remove tissue can be provided on the other hand.The cryogenic ablation system that provides can be provided described method, and this system comprises the bar with near-end and far-end; One or more through described bar from the send inner chamber of near-end to remote extension; One or more through described bar from the aspiration lumen of near-end to remote extension; With described one or more inner chamber and coupled fluid control devices of one or more aspiration lumen fluids sent; Through the cryogenic ablation probe that described bar extends, wherein said cryogenic ablation probe has the cryogenic ablation tip near the far-end of described bar; And with the coupled cryogenic ablation energy of described cryogenic ablation probe operation so that the cryogenic ablation energy is delivered to the cryogenic ablation tip.Described method also can comprise the far-end of the bar that adopts the close ablation site in ultra sonic imaging location; Through described one or more inner chambers of sending liquid is delivered to ablation site; Remove fluidic at least a portion of ablation site through described one or more aspiration lumen; With the cryogenic ablation energy selectivity be delivered to the cryogenic ablation tip to remove the tissue at ablation site place; Wherein the cryogenic ablation energy send be transported to the cryogenic ablation tip in or in seclected time before it fluid is delivered to and melts the site; Wherein be delivered to ablation site in the seclected time after the cryogenic ablation energy is delivered to the most advanced and sophisticated termination of cryogenic ablation.Described method can be chosen wantonly to be included under the temperature that is lower than 20 ℃ fluid is delivered to ablation site.
Can provide tissue expander equipment on the other hand, this equipment comprises the ultrasonic echo generation bar with near-end and far-end, wherein the longitudinal axis extends between near-end and far-end, and wherein said bar is the form of hollow pipe, and the pole length of wherein said bar along the longitudinal axis from near-end to remote extension; The expansion gear of the far-end of close described bar, wherein said expansion gear has the configuration of subsiding and expanded configuration, wherein said expansion gear has the radial dimension with respect to the longitudinal axis in respectively subside configuration and expanded configuration, and the radial dimension of wherein taking the expansion gear of expanded configuration is at least 1.25 times (or being at least 1.5 times in some cases) of radial dimension of expansion gear of taking to subside configuration, the form of the optional inflatable bladders of wherein said expansion gear, and wherein said expansion gear is along at least 25% of described bar extension rod length; With along described bar from near-end to the inner chamber of remote extension, wherein said inner chamber is through one or more hole and expansion gear internal fluid communication of opening to expansion gear inside, extend the optional inside through described pipe of wherein said inner chamber.
Listed the details of one or more embodiments in the following drawings and description.Further feature and possible advantage can be understood from description, accompanying drawing and claims.
The accompanying drawing summary
Figure 1A and 1B show the far-end of an embodiment of cryogenic ablation device, comprise the cryogenic ablation probe that extends through bar.
Fig. 2 A and 2B show an alternative embodiment of cryogenic ablation device, comprise the cryogenic ablation probe that extends through bar.
Fig. 3 show can (shown in wherein four-headed arrow) moves between extended position and retracted position cryogenic ablation probe.
Fig. 4 is the block diagram of an exemplary cryogenic ablation system, comprises cryogenic ablation device, fluid control appliance, the cryogenic ablation energy and the system controller that can be connected with cryogenic ablation energy operability with the fluid control appliance.
Fig. 5 is the side view of tissue expander equipment with expansion gear of the configuration that subsides.
Fig. 6 is the side view of tissue expander equipment shown in Figure 5 with expansion gear of expanded configuration.
Fig. 7 is the end-view along the longitudinal axis of the bar of tissue expander equipment shown in Figure 6.
Fig. 8 is the cutaway view of another exemplary embodiment of the tissue expander equipment that can use with device described herein and system.
Reference marker similar in the different accompanying drawings is indicated similar element.
Exemplary describes in detail
In the detailed description of following exemplary,, wherein showed particular of the present invention by explanation with reference to the numeral together that constitutes an accompanying drawing part.It should be understood that also and can use other embodiment, and can make structural modification and do not depart from the scope of the present invention.
Figure 1A and 1B show the far-end of an embodiment of cryogenic ablation device, comprise the cryogenic ablation probe 111 that extends through bar 110.Bar 110 also comprises two or more inner chambers 112 and 113.In described two or more inner chambers, one or more inner chambers can be used for fluid is delivered to ablation site (be called and send inner chamber), and one or more inner chambers are used the fluid (being called aspiration lumen) that removes ablation site.Shown in Figure 1A, inner chamber 112 is operated shown in arrow 102, and its conduct is sent inner chamber with delivering liquid, and inner chamber 113 is operated shown in arrow 103, and it is as fluid and/or the tissue of aspiration lumen with the removal ablation site.
Be mounted with cryogenic ablation probe 111 in the passage 114 in the bar 110, preferably shown in Figure 1A, extend preferably to the far-end of bar 110.Shown in Figure 1A, cryogenic ablation probe 111 can extend beyond the far-end of bar 110, thereby the far-end of bar is left at the tip 101 of cryogenic ablation probe 111.
Fig. 2 A and 2B show the alternative embodiment of cryogenic ablation device, comprise the cryogenic ablation probe 211 that extends through bar 210.Bar 210 also comprises two or more inner chambers 212 and 213.In described two or more inner chambers, one or more inner chambers can be used for fluid is delivered to ablation site (be called and send inner chamber), and one or more inner chambers are used the fluid (being called aspiration lumen) that removes ablation site.Shown in Fig. 2 A, inner chamber 212 is operated shown in arrow 202, and its conduct is sent inner chamber with delivery of fluids, and inner chamber 213 is operated shown in arrow 203, and it is as the fluid of aspiration lumen with the removal ablation site.
Shown in Fig. 2 A, stretch out in the passage 214 of cryogenic ablation probe 211 from bar 210, can preferably before arriving bar 210 far-ends, stop.So the outer wall of bar 210 can form guard shield on the part of cryogenic ablation probe 211.Shown in Fig. 2 A, the tip 201 of cryogenic ablation probe 211 still is preferably placed at the position above bar 210 far-ends.
Though with respect to residing bar, the cryogenic ablation probe of cryogenic ablation described herein system can have settling position, thereby the cryogenic ablation probe maintains the fixed position with respect to described bar, but in some embodiments, the cryogenic ablation probe can move with respect to described bar.Fig. 3 shows an embodiment of this optional feature, and shown in wherein four-headed arrow, cryogenic ablation probe 311 can move between extended position and retracted position.On extended position, advance (seeing dash area and cross reference number 301a among the figure) along the distal direction that leaves bar 310 in the tip of probe 311, thereby the far-end of probe tip and bar 310 separates.As shown in Figure 3, on retracted position, the far-end of the tip 301 more close bars 310 of probe 311, in some embodiments, but its retraction bar 310.
Fig. 4 is the block diagram of exemplary cryogenic ablation system, the cryogenic ablation energy 430 that cryogenic ablation device 410, the fluid control appliance 420 that can be connected with cryogenic ablation device 410 fluids, the cryogenic ablation probe (not shown) operability that can provide with the part as cryogenic ablation device 410 are connected is provided in wherein said system, and the system controller 440 that can be connected with the cryogenic ablation energy 430 operability with fluid control appliance 420.
Except cryogenic ablation described herein system, the present invention also includes the tissue expander equipment that may be used to the cryogenic ablation probe that path is provided and/or may be used solely to provide tissue expander.
In an exemplary embodiment, described tissue expander equipment can comprise the bar that at one end has pointed or cone point, has the fluid connection fittings at the other end.Can be preferably expansion gear (its form be, for example inflatable bladders) be connected on the bar, near the far-end of this bar.
Described bar can be a hollow, thereby can be as described herein through described bar delivery of fluids, and/or the size of the described bar of scalable is so that as the sleeve pipe operation that has one or more inner chambers, thereby can be used for one or more work apparatus, fluid etc. are delivered to the target body tissue.For example, described bar can be used for transporting the cryogenic ablation probe.
Described bar can have any required thickness, but described bar may preferred No. 10 to No. 30.Preferred described bar is a rigidity substantially, makes its during normal use remarkable deflection (for example, described bar can provide the material of required rigidity to make by metal or other) not.
Though preferably construct described bar with rustless steel, also available a lot of other materials replace.Yet in general, preferably ultrasonic echo can take place at least some materials that are used for described bar, and wherein the echo generating material is the material that can utilize ultrasonic energy visual observations or guiding.In some cases, described bar can be for example through being coated with or doing other processing (for example, etching) and improve it by the ability of ultrasound detection.
In some embodiments, described bar can have solid tip (relative with the open tip of for example spinal needle), and the inner chamber that limits in the hollow bar can stop at one or more opening parts that pass the bar sidewall.These openings can be preferably and the aerating gasbag internal fluid communication that is connected in described bar.The significance of equipment when in some cases, described opening can improve the echo generation with raising use ultrasonic energy.Use a plurality of openings of opening to expansion gear inside to can be used for determining that more accurately expansion gear is the position.
The near-end of described bar can comprise for example fluid connection fittings of Lu's dust snap close accessory (Luer lock fitting) etc., treats the fluid supply sent through the inner chamber of bar thereby the close property of liquid is connected in.In use, described accessory can be connected in syringe or other fluid delivery device.Using the path sleeve pipe one or more work apparatus to be delivered in the embodiment of target body tissue, the near-end of described bar can as described hereinly comprise one or more for example union joints of work apparatus, cryogenic ablation probe etc. that are connected to.
Can change the length of described bar according to the demand of user, though in some embodiments, the length of described bar can be for example 200 millimeters (mm) or shorter (length from near-end to the far-end measuring bar).In some embodiments, described length is preferred 100 millimeters or shorter.Expansion gear (for example inflatable bladders) preferably account for pole length about 10% or more than.In other embodiments, expansion gear can account for pole length 25% or more than.With regard to actual size, expansion gear can have for example 5 millimeters or longer, 10 millimeters or longer, 20 millimeters or longer or even 50 millimeters or longer length.
The position can be the form of one or more inflatable bladders near the expansion gear of device far end.The material that is used for described air bag can preferably have pliability, and configuration is so that be delivered to desired location thereby expansion gear can be taked to subside, and expansion gear can expand into expanded configuration in this position.Suitable material can comprise for example polyethylene etc.Bag material preferably allows the transmission of ultrasonic energy, thereby can utilize ultrasonic energy to detect the part that described bar is positioned at air bag.
Expansion gear can preferably have smaller profile or shape, and is for example similar to the size of the bar that expansion gear is installed.Take the expansion gear of expanded configuration can present multiple shape.Take the example of some possible shapes of expanded configuration to include but not limited to: long narrow square, subsphaeroidal, spherical, two leaf or leafy shapes etc.
When launching tissue expander equipment, can adopt ultrasonic guidance that described bar is directed to intravital desired location, wherein the expansion gear configuration that preferably subsides.This process is similar in ultrasonic guidance injection and/or other operation as herein described used.Described bar can for example pass through narrow residing zone, places zone to be expanded up to expansion gear (for example air bag).
Along with expansion gear is in place, this expansion gear can expand into expanded configuration from the configuration that subsides subsequently.When expansion gear was the form of inflatable bladders, preferably via feeding fluid, for example sterile distilled water, the aseptic ultrasound gel of the degassing etc. caused expanding.The not echogenic fluid of preferred use, thus the ultrasonic visual observations to the expansion position can be significantly not influenced in expansion process.The also preferred expansion that utilizes ultra sonic imaging (concomitant ultrasound imaging) together or any other suitable visual inspection techniques monitoring (for example visual observations) expansion gear to cause.Expansion gear can be kept any selected time of its expanded configuration, for example from several seconds to a few minutes.In addition, expansion gear can only expand and subside once or can optionally expand repeatedly and subside so that required tissue bulking is provided.If expansion gear expands repeatedly and subsides, swell increment can change, and for example, the size of expansion gear can increase gradually with each expansion etc.
Fig. 5 is the side view of an exemplary of tissue expander equipment 510, and wherein expansion gear 502 is taked the configuration that subsides.Fig. 6 is the side view of tissue expander equipment 510 among Fig. 5, and wherein expansion gear 502 is taked expanded configuration.Fig. 7 is the end-view along the longitudinal axis acquisition of the bar of tissue expander equipment among Fig. 5.
Tissue expander equipment 510 among Fig. 5-7 comprises bar 504, and bar 504 has the inner chamber 503 through its extension.Bar 504 comprises optional diagonal cut joint 501 at its far-end, and this opening preferably seals or seals, and expands to allow expansion gear 502.Bar 504 also can comprise accessory 505 so that the connection of fluid delivery device (for example, syringe, pump etc.) or other union joint at its near-end, thereby is adapted to work apparatus as discussed herein.
Though two blades of expansion gear 502 all expand (shown in Fig. 6-7), in some embodiments, different blade can optionally expand (by for example through different inner chamber delivering liquids etc.).And though expansion gear 502 is described as being included in the bar 504 with the configuration that subsides, expansion gear 502 also can wrap on the outer surface of bar 504 (mode is similar to the heart balloon dilator).
Though can be (wherein for example through the main channel of bar 504, the distal seal of bar 504) delivering liquid and fill expansion gear 502, but be positioned at bar 504 (if hollow) or place the outside accessory channel of bar 504 (no matter bar 504 solid still hollows) to can be used to that fluid is delivered to expansion gear 502 and/or remove the fluid of expansion gear 502.If bar 504 is a hollow, and accessory channel is used for expanding expansion gear 502, and then hollow bar 504 may be used for being delivered to position in the body with other fluid described herein (for example therapeutant etc.) or such as other devices such as cryogenic ablation probes.
Fig. 8 is the cutaway view of another exemplary embodiment of tissue expander equipment 610, and wherein expansion gear 602 is positioned on the outer surface of mobile jib 604 with the form of hollow gasbag.Expansion gear 602 is communicated with inner chamber 612 fluids by auxiliary rod 606, and described auxiliary rod 606 separates with the main channel 605 of extending through mobile jib 604.So fluid can be delivered to expansion gear 602 and/or removes from expansion gear 602 through inner chamber 612.Though auxiliary rod 606 is described as linking to each other with mobile jib 604, this connection is chosen wantonly.
When expansion gear 602 was in select location, expansion gear 602 can expand into expanded configuration (as shown in Figure 8).Other device (for example cryogenic ablation probe etc.), fluid (for example therapeutant etc.) are introduced near the position the expansion gear 602 of expansion in the main channel 605 that can utilize mobile jib 604 then.
In some cases, mobile jib 604 can be flexible, when supporting member (pin of for example solid or hollow etc.) was positioned at main channel 605 (advancing to select location promoting to give the enough hardness of mobile jib 604), mobile jib 604 and the expansion gear 602 that subsides were introduced selected body part.(may be in expansion state) after expansion gear 602 is in select location, supporting member can be removed from main channel 605, and mobile jib 604 and its main channel 605 are as sending the given channel of other device, fluid etc. by it.For example, can adjust the size of main channel 605 so that cryogenic ablation device (cryogenic ablation device for example described herein) 605 advances through the main channel.
Though mobile jib 604 can itself be the echo generation, but in some embodiments, when being used for the ultrasonic energy substantially transparent of transmitting tissue's expansion device, property takes place echo can be provided by supporting member (if using) at mobile jib 604 and expansion gear 602.In this type of embodiment, can remove echo generation supporting member, so that expansion gear 602 unfolded body parts are carried out without hindrance ultrasonic visual observations (in these embodiments, mobile jib 604 and expansion gear 602 do not have the echo generation).In also having another kind of situation of change, when mobile jib 604 did not have the echo generation, auxiliary rod 606 can have the echo generation, thereby can utilize ultrasonic guidance location expansion gear 602, and wherein the area-of-interest of mobile jib 604 coverings still less.
In addition, in some embodiments, can provide the fluid pressure in the pressure monitor sensor expansion gear.
System described herein, equipment and method can be advantageously and system described below, equipment and method coupling: for example the denomination of invention of submitting on the same day with this paper is " entering systemic system; apparatus and method " (SYSTEMS, DEVICES AND METHODS FOR ACCESSING BODY TISSUE) PCT number of patent application PCT/US09/34659 and/or the denomination of invention of submitting on February 20th, 2008 are the U.S. Provisional Patent Application serial number 61/030,009 of " entering and treat bodily tissue " (ACCESSING AND TREATING BODY TISSUE).
Word used herein " preferably " and " preferably " refer to give in some cases the embodiment of some benefit.Yet other embodiment also can be preferred under identical and other situation.In addition, narrate one or more preferred embodiments and do not hint that other embodiment is unavailable, and and be not intended to other embodiment eliminating outside scope of the present invention.
" one (individual) " used herein, " being somebody's turn to do ", " at least one (individual) " and " one (individual) or many (individual) " are used interchangeably.So for example, a cryogenic ablation probe can refer to one, two or more cryogenic ablation probes.
Term " and/or " mean one or all listed elements, or any two or more listed combination of elements.
As every part of patent, patent document and publication are included in separately, the full content of the patent of this paper identification, patent document and publication is included this paper by reference in full in.
Exemplary embodiment has been discussed also with reference to possible change in the scope of the invention.These and other changes and improvements it will be apparent to those skilled in the art that, can not depart from the scope of the present invention, and should understand the exemplary that the present invention is not limited to set forth herein.Therefore, the present invention the following claim that provides and its only is provided is equal to the restriction of clause.
Claims (20)
1. cryogenic ablation system that ultrasonic artifacts alleviates, described system comprises:
The bar that comprises near-end and far-end;
One or more through described bar from the send inner chamber of described near-end to described remote extension;
One or more through described bar from the aspiration lumen of described near-end to described remote extension;
With described one or more inner chamber and coupled fluid control appliances of described one or more aspiration lumen fluid sent;
Through the cryogenic ablation probe that described bar extends, wherein said cryogenic ablation probe comprises the cryogenic ablation tip near the described far-end of described bar;
With the coupled cryogenic ablation energy of described cryogenic ablation probe operation, so that the cryogenic ablation energy delivery is arrived described cryogenic ablation tip;
With the system controller that described fluid control appliance is connected with described cryogenic ablation energy operability, wherein said system controller also:
Control the running of described fluid control appliance, thereby fluid is one or morely sent the described far-end that inner chamber is delivered to described bar through described, and have at least a part of fluid to remove from the described far-end of described bar through described one or more aspiration lumen;
Control the running of the described cryogenic ablation energy, so as with the cryogenic ablation energy selectivity be delivered to described cryogenic ablation tip;
Wherein said system controller is operated described fluid control appliance, thereby at the described far-end that the cryogenic ablation energy delivery in the seclected time in described cryogenic ablation tip or before it is delivered to fluid described bar;
And wherein said system controller is operated described fluid control appliance, thereby at the described far-end that the cryogenic ablation energy delivery in the seclected time after most advanced and sophisticated the termination is delivered to fluid described bar to described cryogenic ablation.
2. the system as claimed in claim 1 is characterized in that, described fluid control appliance also comprises temperature control device.
3. the system as claimed in claim 1 is characterized in that, described cryogenic ablation probe remains on the fixed position with respect to described bar.
4. the system as claimed in claim 1, it is characterized in that, described cryogenic ablation probe can move in described bar, thereby described cryogenic ablation probe comprises retracted position, the tip of wherein said cryogenic ablation probe is near the described far-end of described bar, also comprise extended position, the described tip of wherein said cryogenic ablation probe and the described far-end of described bar separate.
5. cryogenic ablation device, it comprises:
The bar that comprises near-end and far-end;
One or more through described bar from the send inner chamber of described near-end to described remote extension;
One or more through described bar from the aspiration lumen of described near-end to described remote extension;
Through the cryogenic ablation probe that described bar extends, wherein said cryogenic ablation probe comprises the cryogenic ablation tip near the described far-end of described bar;
Wherein said cryogenic ablation probe can move in described bar, thereby described cryogenic ablation probe comprises and comprises retracted position, the tip of wherein said cryogenic ablation probe is near the described far-end of described bar, also comprise extended position, the described tip of wherein said cryogenic ablation probe and the described far-end of described bar separate.
6. method of removing tissue, described method comprises:
The cryogenic ablation system is provided, and this system comprises:
The bar that comprises near-end and far-end;
One or more through described bar from the send inner chamber of described near-end to described remote extension;
One or more through described bar from the aspiration lumen of described near-end to described remote extension;
With described one or more inner chamber and coupled fluid control appliances of described one or more aspiration lumen fluid sent;
Through the cryogenic ablation probe that described bar extends, wherein said cryogenic ablation probe comprises the cryogenic ablation tip near the described far-end of described bar;
With the coupled cryogenic ablation energy of described cryogenic ablation probe operation, so that the cryogenic ablation energy delivery is arrived described cryogenic ablation tip;
Adopt ultra sonic imaging that the described far-end of described bar is located near ablation site;
Through described one or more inner chambers of sending fluid is delivered to described ablation site;
Remove at least a portion fluid through described one or more aspiration lumen from described ablation site; And
With the cryogenic ablation energy selectivity be delivered to described cryogenic ablation tip, to remove the tissue of described ablation site;
Wherein in the seclected time when the cryogenic ablation energy is delivered to described cryogenic ablation tip or before it fluid is delivered to described ablation site;
And wherein the cryogenic ablation energy delivery is being delivered to described ablation site with fluid to described cryogenic ablation in the seclected time after most advanced and sophisticated the termination.
7. method as claimed in claim 6 is characterized in that, also is included under the temperature that is lower than 20 ℃ and fluid is delivered to described ablation site.
8. method as claimed in claim 6, it is characterized in that, described cryogenic ablation probe can move in described bar, thereby described cryogenic ablation probe comprises retracted position, the tip of wherein said cryogenic ablation probe is near the described far-end of described bar, also comprise extended position, the described tip of wherein said cryogenic ablation probe and the described far-end of described bar separate, and described method is included in mobile described cryogenic ablation probe between described retracted position and the described extended position.
9. method as claimed in claim 8 is characterized in that, in the mobile described cryogenic ablation probe fluid is delivered to described ablation site between described retracted position and described extended position.
10. tissue expander equipment, it comprises:
Comprise the ultrasonic echo generation bar of near-end and far-end, wherein be extended with the longitudinal axis between described near-end and described far-end, wherein said bar comprises pipe, and wherein said bar comprises along the described longitudinal axis from the pole length of described near-end to described remote extension;
The expansion gear of the described far-end of close described bar, wherein said expansion gear comprises subside configuration and expanded configuration, wherein said expansion gear includes the radial dimension with respect to the described longitudinal axis in described subside configuration and described expanded configuration, and the radial dimension of described expansion gear that wherein is in described expanded configuration is greater than the radial dimension of the described expansion gear that is in the described configuration that subsides; And
Along described bar from the inflation lumen of described near-end to described remote extension, the internal fluid communication of wherein said inflation lumen and described expansion gear.
11. equipment as claimed in claim 10 is characterized in that, also comprises the main channel of extending between the opening of the opening of described proximal end and described far-end through described bar.
12. equipment as claimed in claim 10 is characterized in that, described bar comprises rigid rod.
13. equipment as claimed in claim 10 is characterized in that, described bar comprises the rigid metal bar.
14. equipment as claimed in claim 10 is characterized in that, the radial dimension that is in the described expansion gear of described expanded configuration is at least 1.5 times of radial dimension that are in the described expansion gear of the described configuration that subsides.
15. equipment as claimed in claim 10 is characterized in that, described expansion gear comprises inflatable bladders.
16. equipment as claimed in claim 10 is characterized in that, described expansion gear is along at least 25% of described bar extension rod length.
17. equipment as claimed in claim 10 is characterized in that, described inflation lumen is through one or more hole and described expansion gear internal fluid communication of opening to described expansion gear inside, and wherein said inflation lumen is extended through the inside of described bar.
18. a cryogenic ablation and a tissue expander tool set that comprises cryogenic ablation device and tissue expander equipment,
Wherein said cryogenic ablation device comprises:
The cryogenic ablation bar that comprises near-end and far-end;
One or more through described cryogenic ablation bar from the send inner chamber of described near-end to described remote extension;
One or more through described cryogenic ablation bar from the aspiration lumen of described near-end to described remote extension;
Through the cryogenic ablation probe that described cryogenic ablation bar extends, wherein said cryogenic ablation probe comprises the cryogenic ablation tip near the described far-end of described cryogenic ablation bar;
And wherein said tissue expander equipment comprises:
The ultrasonic echo generation bar that comprises near-end and far-end, wherein between described near-end and described far-end, be extended with the longitudinal axis, and wherein extend through described bar the main channel, the cryogenic ablation bar that the size of described main channel allows described cryogenic ablation device from the described near-end of described ultrasonic echo generation expanding bar to distal advancement;
The expansion gear of the far-end of close described expanding bar, wherein said expansion gear comprises subside configuration and expanded configuration, wherein said expansion gear includes the radial dimension with respect to the described longitudinal axis in described subside configuration and described expanded configuration, and wherein be in described expanded configuration described expansion gear radial dimension greater than the described expansion gear that is in the described configuration that subsides radially
Size; And
Along described expanding bar from the inflation lumen of described near-end to described remote extension, the internal fluid communication of wherein said inflation lumen and described expansion gear.
19. complete set of equipments as claimed in claim 18 is characterized in that, described complete set of equipments also comprises:
With described one or more inner chamber and coupled fluid control appliances of described one or more aspiration lumen fluid sent;
With the coupled cryogenic ablation energy of described cryogenic ablation probe operation, so that the cryogenic ablation energy delivery is arrived described cryogenic ablation tip; And
With the system controller that described fluid control appliance is connected with described cryogenic ablation energy operability, wherein said system controller also:
Control the running of described fluid control appliance, thereby fluid is one or morely sent the described far-end that inner chamber is delivered to described bar through described, and have at least a part of fluid to remove from the described far-end of described bar through described one or more aspiration lumen;
Control the running of the described cryogenic ablation energy, so as with the cryogenic ablation energy selectivity be delivered to described cryogenic ablation tip;
Operate described fluid control appliance, thereby at the described far-end that the cryogenic ablation energy delivery in the seclected time in described cryogenic ablation tip or before it is delivered to fluid described bar; And
Operate described fluid control appliance, thereby at the described far-end that the cryogenic ablation energy delivery in the seclected time after most advanced and sophisticated the termination is delivered to fluid described bar to described cryogenic ablation.
20. complete set of equipments as claimed in claim 18, it is characterized in that, described cryogenic ablation probe can move in described cryogenic ablation bar, thereby described cryogenic ablation probe comprises retracted position, the tip of wherein said cryogenic ablation probe is near the described far-end of described bar, also comprise extended position, the described tip of wherein said cryogenic ablation probe and the described far-end of described bar separate.
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| PCT/US2009/034688 WO2009105649A2 (en) | 2008-02-20 | 2009-02-20 | Ultrasound guided systems and methods |
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| EP (1) | EP2244638A4 (en) |
| CN (1) | CN102065775B (en) |
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| CN104271047A (en) * | 2012-10-04 | 2015-01-07 | 株式会社东芝 | Ultrasonic medical device and ultrasonic diagnostic device |
| CN104271047B (en) * | 2012-10-04 | 2016-05-11 | 株式会社东芝 | Ultrasonic therapy device, diagnostic ultrasound equipment |
| US10123771B2 (en) | 2012-10-04 | 2018-11-13 | Toshiba Medical Systems Corporation | Ultrasound medical apparatus and ultrasound diagnosis apparatus |
| CN106102626A (en) * | 2014-04-11 | 2016-11-09 | 奥林巴斯株式会社 | Plasma disposal system |
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| CN110022775A (en) * | 2016-11-28 | 2019-07-16 | 巴德股份有限公司 | Ultrasonic wave opens medical device components and its method |
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Also Published As
| Publication number | Publication date |
|---|---|
| WO2009105649A3 (en) | 2009-11-26 |
| AU2009215404B2 (en) | 2014-09-18 |
| EP2244638A2 (en) | 2010-11-03 |
| US20110118601A1 (en) | 2011-05-19 |
| AU2009215404A1 (en) | 2009-08-27 |
| US20170105792A1 (en) | 2017-04-20 |
| WO2009105649A2 (en) | 2009-08-27 |
| CN102065775B (en) | 2015-01-07 |
| CA2715895A1 (en) | 2009-08-27 |
| EP2244638A4 (en) | 2013-05-15 |
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